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### Question: How is Nissen fundoplication done?
### Response: A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure, your surgeon will:
First repair the hiatal hernia with stitches. The surgeon will tighten the opening in your diaphragm to keep your stomach from bulging through.
Your surgeon will then use stitches to wrap the upper part of your stomach around the end of your esophagus. This creates pressure at the end of your esophagus and helps prevent stomach acid and food from flowing back up. Surgery is done while you are under general anesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
Ways your doctor may do this surgery are:
Open repair. Your surgeon will make an incision (cut) in your belly area (abdomen). Sometimes the surgeon will place a tube from your stomach through the abdominal wall to keep your stomach in place. This tube will be removed when you no longer need it. Laparoscopic repair: Your surgeon will make 3 to 5 small incisions in your belly. Your surgeon will insert a laparoscope (a thin, hollow tube with a tiny camera on the end) through one of these incisions and other tools through the other incisions. The laparoscope is connected to a video monitor in the operating room that allows your surgeon to see inside your belly and do the repair. The surgeon may need to switch to an open procedure if there is bleeding, a lot of scar tissue from earlier surgeries, or the patient is very overweight.
Endoluminal fundoplication is a new procedure that uses a special camera called an endoscope. The tube is passed down through your mouth and into your esophagus. Your doctor will place small clips on the inside where the esophagus meets the stomach. These clips help prevent food or stomach acid from coming back. An endoscope is similar to a laparoscope. This procedure is done to help prevent reflux.